1. Dialectical Behavior Therapy: (DBT)
Philosophy and Applications

2. DBT Clientele Attributes
Unbalanced interpersonal relationships
Unstable self-image
Impulsivity
Recurring suicidal or self-harming behavior
Mood instability
Perfectionism
Attachment / abandonment issues
Borderline traits

3. DBT Incorporates: Dialectics Zen tradition
Cognitive behavioral therapy

4. DBT Philosophy Dialectical Worldview
Interconnectedness
Opposing forces.
Thesis – Antithesis – Synthesis – Thesis – Etc.
Walking the middle path.
Change is constant.
Example: Cutting relieves emotional pain versus health implications and dangers= Finding healthy ways to relieve emotional pain.

5. Choose the Dialectical Statement
People hate me / everyone thinks I am the coolest / some people enjoy being around me and others do not.
I can’t do anything right / I have strengths and things I am learning / I have it all figured out
There are things I like and dislike about others/ I hate them / They are so perfect

6. DBT Philosophy Zen Tradition
Mindfulness
Wide mind
Non-judgmental stance
Observing
Acceptance as a balance to change
Irreverence versus warmth
Radical acceptance
Example: Clients may not have caused all of their own problems, AND they have to solve them anyway.
Tao Te Ching: So it is that existence and non-existence give birth the one to
(the idea of) the other; that difficulty and ease produce the one (the
idea of) the other;

7. DBT Filosophy Cognitive Behavioral Therapy
Thoughts, feelings, behaviors.
Eliminate negative secondary gains.
Example: Crisis call to therapist after self-harming, therapist will ensure 911 is called and call will end.
Behavior skills training.
Example of Dear Man

8. Mindfulness Activity What Skills: How Skills:
Observe: Pay attention to what is Non-Judgmentally: See and do not
going on around you. 5 senses. evaluate. Do not judge your judging.
Describe: Use words to say what Stay Focused: Do one thing at a time,
you are observing. let go of distraction, concentrate.
Participate: Enter the experience Do What Works: Act skillfully, play by
fully. the rules, let go of feelings that hurt you.
Balance Rational and Emotional. Ex: Often rationalizing with someone in an emotional stated is very ineffective.

9. Biosocial Theory of BPD
Emotional vulnerability
Invalidating environments.
Biological issues.
One cannot ignore the 75% prevalence of sexual abuse among those diagnosed with BPD.
Some kids are Orchids versus Dandelions in terms of resilience and vulnerability.
Some kids are an 8 pack of crayons versus a 64 pack in terms of emotional intensity and complexity.

10. DBT Therapy Assumptions
Clients are doing the best they can.
Clients want to improve.
Clients need to do better, try harder, and be more motivated to change.
Clients must learn new behaviors in all relevant contexts.
Clients cannot fail in DBT.
Clients may not have caused all their problems, and they have to solve them anyway.
The lives of suicidal BPD clients are unbearable as they are currently being lived.

11. Modes of DBT Individual Therapy
Individual therapist is main contact.
Commitment to program and safety
Eliminate life threatening and therapy-interfering behaviors.
Improve quality of life.
PTSD treatment, application of skills, and self concept development.
Processing is to take place in individual therapy.

12. Links and Chains Mad Lib
Relates to LRBI Manual ABC Observation form in Behavioral Intervention Plans.

13. Modes of DBT Group Skills Training
In parallel with individual therapy – skills focus.
Core mindfulness
Interpersonal effectiveness
Emotional regulation
Distress tolerance
Walking the middle path

14. Interpersonal Effectiveness Activity
Validation Exercise

15. Modes of DBT Telephone Consultation
Individual therapist contact.
Support and assistance with skills before crisis.
Clear limits and boundaries.

16. Distress Tolerance Activities
Radical Acceptance
Ice
Pros and Cons of unhealthy behavior

17. Modes of DBT Therapist Consultation Meeting
Weekly meetings
Team acquires skills
Provides support
Integrates DBT philosophy
Plans treatment for clients.

18. Emotional Regulation Activity
Rope Challenge

19. DBT at Children’s Outpatient
16 weeks of skills group. No more than 2 client absences.
Open ended with entry dates every 4 weeks.
Mandatory guardian and client attendance.
Staff supervision one hour weekly.
YOQ monitoring.
2 hours of group and family/individual session weekly.
Broadened client symptomology.

20. References
Linehan, M. (1993a). Cognitive- behavioral treatment of borderline personality disorder. New York, NY: The Guilford Press
Linehan, M. (1993b). Skills training manual for treating borderline personality disorder. New York, NY: The Guilford Press